=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811636525
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NOEL TASCHNER RBT, BSSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2022
-----------------------------------------------------
Last Update Date | 06/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 124 PARKVIEW DR
-----------------------------------------------------
City | SOUTH SIOUX CITY
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68776-3815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-318-0922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 507 JEFFERSON ST APT 5
-----------------------------------------------------
City | VERMILLION
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57069-2638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-318-0922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | H14026450
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------